All information on the Application, Parental Authorization and Medical Physicians Approval forms MUST be completed in order to guarantee a place in the camp. 

fill out and send it to us at;

CEC Business Services
Purdue University
Stewart Center, Room 110
128 Memorial Mall
West Lafayette, IN. 47907-2034
Fax (765) 494-0567

 
  Session 1 (June10-14, 2008) #5075 Session 2 (June 16-20, 2008) #5076
Name:
Street Address:
City/State/Zip:
Phone Number: Student Cell Phone
Age (as of 6/2008):
Gender: Male Female
Grade (as of Fall 2008):
School:
Average Score
(18 holes):
Name of Parent / Guardian
Email Address:
Roommate
Preference
(if any):
Credit CardType:

Master Card Visa Discover American Express
Check (make checks payable to Purdue University)

Credit Card Number:
Exp. Date :
Name on Card:
please print
Signature: